Opportunities For Prevention Research Articles

Cutaneous lupus erythematosus (CLE) is a complex inflammatory skin disease that presents either in isolation or as a frequent manifestation of systemic lupus erythematosus (SLE). CLE subtypes show clinical heterogeneity and varying associations with SLE. Histologically, CLE is characterized by interface dermatitis, a reaction pattern that involves immune-cell infiltration of the dermo-epidermal junction. In-depth characterization of both non-lesional and lesional lupus skin has reshaped our understanding of pathogenesis. Non-lesional and lesional lupus skin exhibits early and chronic upregulation of type I interferons, which drive photosensitivity, myeloid-cell recruitment and amplification of cytokine responses in both immune and non-immune cells. This detailed understanding of CLE biology has enabled the development of targeted therapies. Ongoing research to identify key pathogenic mechanisms will create opportunities for prevention of CLE and CLE-to-SLE transition.

While acute respiratory-viral-infection (RVI) is associated with elevated short-term risk of concurrent cardiac events, less is known regarding subsequent heart-failure (HF) risk post-RVI hospitalisation. We evaluated risk of HF post-hospitalisation for influenza/COVID-19/respiratory-syncytial-virus(RSV). Population-based retrospective cohort study, including all adult Singaporeans (≥18 years) hospitalised for influenza/COVID-19/RSV (01/01/2017-30/08/2023); stratified by pre-existing HF. Risks of acute HF (new-onset/readmission) post-RVI-hospitalisation was compared against controls (orthopaedic hospitalisations) using overlap-weighted competing-risks-regression. HF was ascertained using national healthcare-claims data. Analyses were further stratified by RVI type and vaccination status. Amongst individuals without pre-existing HF (N=59,408) hospitalised for RVI (influenza/COVID-19/RSV), overall risk of new-onset HF up to 180 days post-hospitalisation was elevated versus controls (adjusted-hazards-ratio, aHR=1.45[95%CI=1.26-1.67]). Risk of new-onset HF was observed up to 180 days post-hospitalisation for specific RVIs (RSV: aHR=2.03[95%CI=1.26-3.25]; COVID-19: aHR=1.36[95%CI=1.16-1.60]; influenza: aHR=1.62[95%CI=1.28-2.06]); however, risk was not significantly increased amongst influenza hospitalisations vaccinated <365 days prior (aHR=1.47[95%CI=0.82-2.64]). In HF patients (N=4163) hospitalised for RVI(influenza/COVID-19/RSV), risk of HF readmission was similarly increased (aHR=1.28[95%CI=1.08-1.52]). No increased risk of HF readmission post-COVID-19 was observed amongst individuals who received ≥4 COVID-19 vaccine doses (aHR=0.86[95%CI=0.59-1.27]), or who were vaccinated <180 days prior (aHR=0.97[95%CI=0.79-1.20]). Similarly, risk of HF readmission post-influenza was not significantly increased amongst individuals vaccinated <365 days prior (aHR=1.63[95%CI=0.94-2.82]). Elevated risk of HF readmission post-RVI hospitalisation predominantly accrued in older patients (≥70 years). RVIs can contribute to post-acute risk of new-onset HF and HF readmissions. Vaccination represents an opportunity for HF prevention amongst at-risk individuals.

Background: Ischemic diseases are major global health burden, contributing significantly to cardiovascular and cerebrovascular disorders, with ischemic stroke being a leading cause. The main risk factors for ischemia are vascular wall damage, atherosclerosis progression, lipid metabolism disturbances, and increased platelet aggregation. Current medications targeting these mechanisms may lead to side effects, especially when they are used for prevention, driving interest in plant-derived compounds with cardiovascular and cerebrovascular benefits. Sour cherry (Prunus cerasus) has attracted attention for its high levels of polyphenols, anthocyanins, flavonoids, and organic acids, known for their blood pressure-regulating, anti-inflammatory, and sleep-modulating properties. These compounds protect the vascular system by reducing oxidative stress, inflammation, and endothelial dysfunction. Investigation of sour cherry cerebrovascular and anti-hyperlipidemic properties may contribute to integrating plant-based therapies into existing cardiovascular treatment strategies, offering new opportunities for disease prevention and management. Objectives: The purpose of this observation was to investigate the antihyperlipidemic activity and discover the new cerebrovascular effects of sour cherry fruits. Results: Obtained data evidenced that cholesterol levels in blood samples after 7 days of fruit intake were decreased by 2.74±1.52% compared with baseline parameters (day 0). Continued sour cherry fruit intake for 14 days led to further reduction in cholesterol levels by 8.1±3.30%, nearly three times exceeding the reduction level registered on day 7. Assessment of sour cherry fruits on triglyceride levels showed a significant reduction on days 7 and 14 by 17.86 ± 5.57% and 21.01 ± 9.25%, respectively, compared to baseline. No notable changes were observed in high-density lipoprotein (HDL) levels following sour cherry fruit intake. In contrast, low-density lipoprotein (LDL) levels decreased by 8.1 ± 4.24% after 14 days of consumption compared with control values. Registration of brain blood flow enabled the discovery of cerebrovascular activity in sour cherry fruits. It is noteworthy that its ability of sour cherry fruits to increase the cerebral blood flow (CBF) appears especially in case of cerebral blood flow impairment. Thus, under the normal condition, cerebral blood flow after intraperitoneal injection of 2.5 g/kg freeze-dried sour cherry fruit solution was not changed significantly. After the ligation of right common carotid artery, when CBF was decreased by 31.07±3.96% (p&lt;0.05) intraperitoneal administration of the freeze-dried sour cherry fruits solution (2.5 g/ kg) was accompanied by the elevation of CBF, being above from occlusion levels by 13.6±5.19% ( p&lt;0.05) at 30 minutes, and by 33.8±6.06% -at 80 minutes, compared to occlusion values. Notably, by the end of the experiment, CBF levels exceeded not only the occlusion level by 40.04±12.51%, as well as the baseline level. Conclusion: The findings of this study suggest that sour cherry fruits possess cerebrovascular and antihyperlipidemic activity, as based on their ability to improve impaired cerebral blood flow and reduce cholesterol and triglyceride levels. These results highlight the potential of sour cherry as a natural and effective plant-based agent for reducing cardiovascular disease risk factors, including hypercholesterolemia. Keywords: common carotid artery occlusion, new cerebrovascular activity, lipid spectrum changes, freeze-dried sour cherry.

Background Cardiac arrest (CA) is common but deadly. Prior hospitalisation represents a missed opportunity for prevention and identification of high-risk groups before CA. This study aims to determine the extent of and underlying reasons for hospitalisations during the 30-day period preceding an admission with CA. Methods We conducted a retrospective cohort study using the United States National Readmission Database (NRD) during 2018–2020. We evaluated hospitalisations with a diagnosis of CA and admissions in the 30-day period before hospitalisation with CA. Multiple logistic regressions were used to identify factors associated with prior hospitalisation and mortality on admission with CA. Results Among 1,637,240 hospital episodes with CA, 255,500 (15.6%) had an admission to hospital in the 30-day period prior to hospitalisation with a diagnosis with CA. The categories for causes of previous admissions were disorders of the circulatory system (27%), infectious and parasite disease (13%), and disorders of the respiratory system (12%). The most common diagnoses were sepsis, hypertensive heart and renal disease, acute myocardial infarction, and respiratory failure. Cancer (OR 2.09 95%CI 2.04–2.15, p < 0.001), chronic kidney disease (OR 1.45 95%CI 1.42–1.48, p < 0.001), and chronic lung disease (OR 1.25 95%CI 1.22–1.27, p < 0.001) were the most significant factors associated with prior admission. Previous hospital admission was associated with increased odds of mortality (OR 1.58 95%CI 1.55–1.62, p < 0.001). Conclusions Hospitalisations within the 30-day period preceding an admission with CA are common and occur in about 1 out 6 patients. The most common primary diagnoses for prior hospitalisation were sepsis, renal and cardiovascular disease.

As many as half of individuals who develop psychosis had attended child and adolescent psychiatric services at some stage in childhood, highlighting substantial opportunities for prevention within these services if an effective preventive intervention were identified. The authors hypothesized that adolescent psychiatric patients exposed to doxycycline, an antibiotic with putative neuroprotective properties, would have a lower risk of developing schizophrenia. This was an emulated target trial using nationwide Finnish health register data on all individuals born between 1987 and 1997 who attended adolescent psychiatric services between ages 13 and 18 and had used any antibiotics. Individuals were followed from first dispensed antibiotic prescription up to age 30. The main outcome was recorded schizophrenia diagnosis. The g-formula was used to estimate schizophrenia risk across doxycycline exposure levels (cumulative dose doxycycline use: no doxycycline use; low use, <1,499 mg; medium use, 1,500-2,999 mg; high use, ≥3,000 mg) during different follow-up periods. A total of 56,395 individuals had attended adolescent psychiatric services and had used antibiotics; of these, 16,189 (28.7%) had used doxycycline. The risk of schizophrenia after 10 years of follow-up was 2.1% (95% CI=1.9, 2.3) for individuals who had used non-doxycycline antibiotics. In comparison, the risk of schizophrenia at 10 years was significantly lower in adolescent psychiatric patients treated with doxycycline (low cumulative dose: 1.4%, risk ratio=0.70, 95% CI=0.48, 0.85; medium cumulative dose: 1.4%, risk ratio=0.65, 95% CI=0.25, 1.04; high cumulative dose: 1.5%, risk ratio=0.70, 95% CI=0.43, 0.97). These findings raise the tentative but exciting possibility that doxycycline treatment may reduce schizophrenia risk in adolescent psychiatric patients.

Introduction/Background: Pediatric In-Hospital Cardiac Arrest (P-IHCA) remains a critical patient safety and quality improvement issue. Conventional reviews often fail to capture early opportunities for recognition and prevention. This project addresses these gaps using structured, multidisciplinary reviews guided by experts in pediatric critical care and medical education. Research Questions/Hypothesis: Does implementing a structured, multidisciplinary review methodology with a standardized process for both immediate and retrospective evaluations improve identification of preventable factors associated with P-IHCA. Goals/Aims: To enhance early recognition of clinical deterioration. To systematically identify preventable factors and facilitate targeted interventions. To foster multidisciplinary collaboration. Methods/Approach: Structured reviews were conducted hospital-wide at a quaternary pediatric institution. The process included: (1)- Immediate (hot) debriefs capturing real-time feedback on team performance, communication, and logistics. (2)- Retrospective (cold) debriefs within one month, analyzing monitor data, patient records, and detailed staff interviews. (3)- Systematic event classification using the eStablish And Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) into avoidable, potentially avoidable, or unavoidable. (4)- Multidisciplinary follow-up through dedicated quality improvement pathways, maintaining expert review team involvement. Results/Data: Structured hot debriefs identified real-time issues including communication failures, medication delays, and CPR quality concerns. Structured cold debriefs provided deeper systemic insights such as delays in recognizing clinical deterioration, diagnostic errors, and escalation failures. The reviews highlighted opportunities for improving interdepartmental communication, powered multidivisional collaborative event analyses, and subsequently informing meaningful changes in hospital policies, procedures, and staff training. Conclusion(s): A structured, expert driven, multidisciplinary review process shifts event analysis from describing what happened during a cardiac arrest, to explaining why and how it occurred, thereby revealing upstream factors that improve recognition of decompensation, team response, and CPR performance. This approach facilitates targeted improvements, fostering a safer hospital environment, and potentially improving patient outcomes.

Background: Cardiovascular disease (CVD) is the leading cause of death among women in the US. Adverse pregnancy outcomes, particularly hypertensive disorders of pregnancy (HDP), are increasingly recognized as indicators of future CVD risk. Studies in diverse populations, especially those most affected by maternal morbidity and mortality, are urgently needed to direct guidelines and policy in the US. Objectives: To determine the association between HDP and incident CVD in a diverse, real-world population; assess mediation by postpartum cardiometabolic conditions; and identify sociodemographic and structural correlates of incident postpartum hypertension. Methods: We used linked electronic health record and survey data from the All of Us Research Program. Pregnancy episodes were identified using a validated algorithm. Cox regression and causal mediation models were used to estimate associations overall and stratified by the presence of pre-pregnancy cardiometabolic conditions (i.e., hypertension, obesity, diabetes, hyperlipidemia, and chronic kidney disease). Logistic regression was used to assess correlates of incident postpartum hypertension. Results: Participants (n = 17,673) had a mean age of 30 years [IQR: 25, 35] years; 16% identified as Black, 42% as Hispanic, 35% reported a family income &lt; $25,000, and 38% had &lt; high school education. HDP was present in 12% of pregnancies. Over a median follow-up of 4.6 years, 724 women developed incident CVD. HDP was associated with a higher incidence of CVD (12.5 vs. 7.1 per 1,000 person-years; HR 1.85, 95% CI 1.51-2.26) (Figure 1A-1B). Among women without pre-pregnancy cardiometabolic conditions, the associations were stronger. However, the absolute CVD incidence was highest among women with pre-pregnancy cardiometabolic conditions regardless of HDP status (Figure 1B-1C). Incident postpartum hypertension mediated 87% (95% CI: 45, 100) of the association between HDP and CVD. Low income, rurality, and barriers to care, such as transportation and caregiving were associated with higher odds of incident postpartum hypertension (Figure 1D). Conclusion: HDP is a significant early-life marker of premature CVD risk, especially among women without pre-pregnancy cardiometabolic conditions. Interventions that target cardiometabolic health before pregnancy and improve postpartum hypertension management, particularly among underserved populations, represent critical opportunities for CVD prevention across the life course.

Background: Lipid-lowering therapy (LLT) is essential for secondary prevention in patients with atherosclerotic cardiovascular disease (ASCVD). However, real-world data on LLT use, lipid control, and treatment intensification in patients with prior ASCVD who are newly hospitalized with acute myocardial infarction (AMI) are limited. In this nationwide study, we assessed the quality of lipid management for ASCVD patients hospitalized with a new AMI in the U.S. Methods: We evaluated patients with pre-existing ASCVD who were hospitalized with AMI in the NCDR Chest Pain–MI Registry between January 2019 and March 2023. Primary outcomes were outpatient LLT prescription on admission and LDL-C levels checked during or within 6 months prior to hospitalization. Using discharge medication data which were only available after 2020, we also evaluated the proportion of patients discharged on combination LLT (≥2 agents) as a secondary outcome. Variables were compared using Wilcoxon rank-sum tests and chi-square tests as appropriate. Results: The study cohort included 217,812 patients with pre-existing ASCVD admitted with AMI at 677 hospitals. The median (25th, 75th percentile) age was 69 years (60–77), and 31.9% were women. Prior to admission, 31.5% were not prescribed a statin, and only 3.7% were prescribed combination LLT. The median (25th, 75th percentile) serum LDL-C was 81 mg/dL (59–112), including 73 mg/dL (54–99) for statin users vs. 104 mg/dL (77–132) for non-statin users (p&lt;0.001). Among all patients with data available, 20.4% had LDL-C &lt;55 mg/dL and 37.1% had LDL-C&lt;70 mg/dL. Patients previously taking statins were significantly more likely to have lower LDL-C and meet guideline-recommended goals upon admission ( Figure). Among patients with discharge data available, 93.3% were discharged on a statin, 88.9% on a high-intensity statin, and 1.7% on a PCSK9 inhibitor. Only 10.4% of patients were discharged with combination LLT. The median (25th, 75th percentile) percentage of patients discharged on combination LLT across hospitals was 9.0% (5.7-13.0%). Conclusions: Despite having established ASCVD before AMI admission, nearly 1 in 3 patients were not on a statin and only 1 in 5 had appropriate LDL-C levels based on guidelines. Only one in ten patients was prescribed combination LLT at discharge. These findings reflect missed opportunities for secondary prevention and emphasize the need for more aggressive lipid management in the outpatient and inpatient settings.

Although acute rheumatic fever (ARF) is a preventable condition, it continues to be diagnosed in Far North Queensland, Australia. Enhanced primary prevention is necessary to reduce the local burden of ARF and rheumatic heart disease. In this retrospective clinical audit, all cases of definite ARF in the remote Torres Strait and Cape York region of Far North Queensland between January 2020 and December 2024 were examined. Clinical records were reviewed to identify and characterize any healthcare presentations of individuals during the 6 weeks preceding their ARF diagnosis. Of 67 individuals with definite ARF 65 (97%) identified as First Nations Australians; 43/67 (64%) did not present for any healthcare in the 6 weeks preceding their diagnosis; and a further 10/67 (15%) presented for healthcare that was unrelated to group A Streptococcus (Strep A) infection. Overall, a possible Strep A infection (skin infection or sore throat) was identified in 14/67 (21%) patients; 9/67 (13%) patients presented with skin infections, and 5/67 (7%) presented with sore throats. Of these, 5/14 (36%) received appropriate antibiotic treatment. Most individuals with definite ARF in this remote region of Australia do not present for healthcare before their diagnosis; however, there remain opportunities for the primary prevention of ARF among those who do. Culturally considered health promotion, opportunistic screening, and improved recognition and treatment of Strep A infection are critical for reducing ARF incidence in this region of Australia. It is also important to define the contribution of asymptomatic Strep A infections to the pathogenesis of ARF.

Background: South Asians face a disproportionately high burden of atherosclerotic cardiovascular disease (ASCVD), often presenting at younger ages and with fewer traditional risk factors than other populations. Widely used risk prediction tools such as the Framingham Risk Score (FRS), ASCVD Pooled Cohort Equations, and QRISK were developed primarily in White cohorts, while others like WHO/ISH were based on broad regional estimates that may not reflect the higher risk in South Asians. This can lead to under-treatment and missed opportunities for early prevention. Methods: We conducted a systematic review guided by PRISMA methodology, evaluating studies published between 2014 and 2024 that assessed cardiovascular risk in South Asian adults. A PubMed search was performed using the keywords: ("South Asian" OR "Indian" OR "Pakistani" OR "Bangladeshi") AND ("cardiovascular risk" OR "heart disease risk" OR "ASCVD") AND ("Framingham" OR "QRISK" OR "Pooled Cohort Equations" OR "risk prediction"). Studies were included if they evaluated the calibration or performance of models such as FRS, ASCVD, QRISK, JBS3, WHO/ISH, or NORRISK2, or assessed surrogate markers like coronary artery calcium (CAC) or carotid intima-media thickness (CIMT). Results: Fifteen studies met inclusion criteria. Most demonstrated consistent underestimation of ASCVD risk in South Asians using standard models. In one study, recalibration of the FRS resulted in a 9.8% net reclassification into higher-risk categories. Several studies showed that WHO/ISH charts and NORRISK2 poorly correlated with imaging-based risk markers like CAC and CIMT in South Asians, indicating limited predictive value. U.S. based MASALA and MESA analyses reported that South Asians had greater subclinical atherosclerosis than White peers at equivalent risk levels. Across studies key risk factors including elevated lipoprotein(a), family history of premature ASCVD, and CAC scoring were frequently unaccounted for, suggesting missed stratification opportunities. Conclusion: Common cardiovascular risk calculators often underestimate ASCVD risk in South Asian populations. Adapting existing models using South Asian-specific data and incorporating markers such as CAC and lipoprotein(a) may improve risk assessment. These findings highlight the need to reevaluate how South Asian ethnicity is incorporated into risk assessment, potentially deserving greater consideration in risk stratification beyond a secondary enhancer.

Introduction: Incidental coronary artery calcification (CAC) frequently appears on routine chest CT scans and indicates high risk for future atherosclerotic cardiovascular events, presenting an opportunity for prevention. In patients with active or recent cancer diagnosis, such incidental findings may be overlooked or inadequately managed. Evaluating how the incidental CAC finding influences clinical management could provide critical insight into integrative cardiovascular care in oncology populations. We aimed to evaluate whether cancer patients with incidental CAC receive comparable cardiovascular preventive interventions as non-cancer counterparts. Methods: We conducted a retrospective cohort study of patients aged 18-75 years at UCONN Health who had incidental CAC identified on routine non-gated chest CT between January 1, 2020, and December 31, 2023. Patients were stratified into two groups: those with an active or recent cancer diagnosis (n=99) and those without cancer (n=698). After 1:1 propensity score matching on demographic and baseline comorbidities, 99 matched pairs were analyzed. Patients with known pre-existing cardiovascular disease or prior coronary interventions were excluded. Socioeconomic factors were estimated based on ZIP code. Primary outcomes included initiation of statin or aspirin therapy, cardiology referral, stress testing within one year, and all-cause mortality. Group differences were assessed using chi-square tests. Results: After matching, cancer patients had significantly higher all-cause mortality compared to non-cancer controls (20.2% vs. 10.1%, p=0.046). Cardiovascular preventive interventions were significantly less common in cancer patients: statin initiation (40.4% vs. 60.6%, p=0.007), aspirin initiation (21.2% vs. 36.4%, p=0.028), stress testing within one year (0% vs. 9.1%, p=0.006), and cardiology referral within one year (9.1% vs. 26.3%, p=0.003). Conclusions: In this matched cohort study, cancer patients with incidental CAC were significantly less likely to receive preventative cardiovascular interventions and had higher all-cause mortality compared to non-cancer controls. These findings highlight a missed opportunity for cardio-preventive care in oncology populations and support routine integration of cardio-oncology pathways to address incidental CAC in cancer patients.

Accidental poisoning and chemical burn injury in young children is a worldwide problem. A globally adopted system of labelling hazardous substances is intended to reduce this risk, but the pictograms that are central to this are often misunderstood. We sought to discover children's interpretation of Globally Harmonised System of Classification and Labelling of Chemicals pictograms, to promote greater awareness and understanding of them, and to inform public health messages and teaching in schools. An in-person, single-group pretest and post-test intervention study was conducted using an electronic self-completed programme. Children reported perceived meaning of 9 pictograms, which were then explained with examples, before immediate post-test of the pictograms' intended meaning and multiple choice quiz to reinforce learning. An optional family-based activity was included. Only 36% understood the sign for 'toxic' substances. The 'corrosive' pictogram was understood by 53%, but 11% mistook the image to indicate a place or substance for handwashing. The pictogram for 'gas under pressure' provoked incorrect responses from 94%. For these three, post-test showed remarkable improvement (87%, 73%, 75%, respectively). There was little understanding of 'health hazard', 'hazardous to the aquatic environment', 'harmful irritant' and 'oxidising agent' pictograms. Post-test results remained disappointing. Alternative means of responding such as sorting true/false statements, or drawing lines to connect correct objects with corresponding pictograms could be considered for younger children. There was a need to show the pictograms in context for better understanding. Despite a dangerous lack of understanding initially, the programme achieved short-term retention of knowledge at post-test. Secondary prevention opportunities should also be explored.

Environmental toxicants and Parkinson's disease: recent evidence, risks, and prevention opportunities.

Precision prevention refers to the use of data-intensive technologies to detect early indicators of disease and risk factors at the individual level. Precision prevention is not just a policy vision for a distant future but a development currently gaining momentum through wearables and self-tests marketed directly to consumers. We critically analyze one of the applications already on the market, namely detection of asymptomatic atrial fibrillation via smartwatches. We examine the promises made by manufacturers of smartwatches in relation to perspectives of general practitioners (GPs) in Denmark, who experience that new opportunities for disease prevention often come with new challenges. As one informant termed it, heart rate notifications are a form of "unauthorized screening" with uncertain benefits for individual patients and the healthcare system. The case of device-detected asymptomatic atrial fibrillation illustrates how precision prevention, via wellness technologies, can lead to a temporal disruption of evidence. We use this term to highlight the concern that evidence becomes the result of implementation, rather than the basis for it, thus turning consumers into experimental research subjects. The case of heart rate notifications also illustrates how the proactive approach to disease prevention, promoted by the wellness technology industry, drives a need for reactive research evaluating the benefits and harms of detection after the fact. We call for more attention to how big tech expansionism impacts the organization of health care and health research, as well as how the wellness technology industry shapes our understanding of disease and health.

From individual interventions to structural change: Why public health leadership is needed to engage men and boys in violence prevention.

This study aimed to investigate the contributing factors to suicidal behavior and to gather insights from individuals who have attempted suicide regarding potential clinical, psychosocial, and family-based prevention resources. A qualitative research design was employed to explore participants' lived experiences and perceptions surrounding suicidal behavior. Data were collected through semi-structured interviews with 12 individuals (four men and eight women) who had previously attempted suicide, selected using purposive sampling. All participants were admitted to the Emergency Department of a public hospital in Kayseri immediately following their suicide attempts and were subsequently referred to the inpatient psychiatry service for treatment. The data were analyzed using Interpretative Phenomenological Analysis (IPA) to explore participants' lived experiences and meanings. Frequency counts of emergent themes and subthemes were also noted to illustrate their relative prominence, but IPA remained the primary analytic approach. Three main themes emerged from the data: individual, environmental, and relational factors. Individual factors included risk elements such as irrational beliefs, negative emotions, and physical health problems, as well as protective factors like emotional regulation, religious beliefs, and medication use. Environmental factors encompassed financial difficulties and lack of social support as risks, with the presence of social support acting as a protective element. Relational factors involved betrayal, arguments, violence, and punitive desires as risks, while commitment to family members served as a protective factor. Overall, protective factors such as religious beliefs, social support, and family connectedness appear to be particularly effective in reducing suicidal thoughts. Participants with lived experience of suicide attempts made unique contributions to this study by sharing their first-hand perspectives on the personal, social, and relational contexts of suicidal behavior. Their narratives not only shaped the thematic analysis but also highlighted prevention opportunities such as strengthening family connectedness and enhancing social support that may not have emerged through quantitative approaches alone.

The importance of the study is determined by the need for scientific substantiation and timely search for opportunities for pedagogical prevention of extremist manifestations among students in the educational environment of the university. The purpose of the study is to substantiate the importance of taking into account the indicators of the severity of ethnic identity and the level of social self-control of students in the system of pedagogical prevention of extremist manifestations of students in the educational environment of the university. The article proves the need for a timely search for means of pedagogical prevention of extremist manifestations among students in the educational environment of the university based on identifying the severity of their ethnic identity and social self-control. The results of the empirical study assess the strength of ethnic identity and social self-control among students, which allows us to analyse the social contexts that contribute to extremist manifestations in the youth student environment. The scientific novelty of the study is due to the empirical results obtained in the study of the strength of ethnic identity and social self-control among university students, which help to more accurately identify the targets of pedagogical influence in systematic targeted work by the university to prevent extremist manifestations. The empirical results obtained emphasise the importance of pedagogical prevention of extremist manifestations of students, taking into account both ethnocultural and socio-psychological components of the personal development of students in the educational environment of the university.

Depression is associated with immunological and metabolic alterations, but immunometabolic characteristics of developmental trajectories of depressive symptoms remain unclear. Studies of longitudinal trends of depressive symptoms in young people could provide insight into aetiological mechanisms and heterogeneity behind depression, and origins of possible common cardiometabolic comorbidities for depression. Using depressive symptoms scores measured on 10 occasions between ages 10 and 25 years in the Avon Longitudinal Study of Parents and Children (n = 7302), we identified four distinct trajectories: low-stable (70% of the sample), adolescent-limited (13%), adulthood-onset (10%) and adolescent-persistent (7%). We examined associations of these trajectories with: i) anthropometric, cardiometabolic and psychiatric phenotypes using multivariable regression (n = 1565-2828); ii) 67 blood immunological proteins and 57 metabolomic features using empirical Bayes moderated linear models (n = 2059 and n = 2240 respectively); and iii) 28 blood cell counts and biochemical measures using multivariable regression (n = 2246). Relative to the low-stable group, risk of depression and anxiety in adulthood was higher for all other groups, especially in the adolescent-persistent (RRdepression=13.11, 95% CI 9.59-17.90; RRGAD = 11.77, 95% CI 8.58-16.14) and adulthood-onset (RRdepression=6.25, 95% CI 4.50-8.68; RRGAD = 4.66, 95% CI 3.29-6.60) groups. The three depression-related trajectories vary in their immunometabolic profile, with evidence of little or no alterations in the adolescent-limited group. The adulthood-onset group shows widespread classical immunometabolic changes (e.g., increased immune cell counts and insulin resistance), while the adolescent-persistent group is characterised by higher BMI both in childhood and adulthood with few other immunometabolic changes. These findings point to distinct mechanisms and prevention opportunities for adverse cardiometabolic profile in different groups of young people with depression.

Postoperative delirium (POD) is an acute neuropsychiatric syndrome predominantly affecting older adults after surgery, characterized by disturbances in attention, awareness, and cognition. Its incidence ranges from 10% to over 70%, depending on patient vulnerability and surgical type. POD is independently associated with prolonged hospital stays, increased morbidity and mortality, and long-term cognitive decline. The pathophysiology is multifactorial and involves dysregulation at neural, molecular, and cellular levels. Neurotransmitter imbalances, especially acetylcholine deficiency and dopaminergic excess, play a central role. Glutamate excitotoxicity and disrupted GABAergic tone further impair synaptic function. Neuroimaging and EEG reveal disrupted functional connectivity within key networks such as the Default Mode Network (DMN) and Central Executive Network (CEN), alongside cortical slowing and reduced EEG complexity. Molecularly, systemic inflammation triggered by surgery—marked by elevated IL-6, TNF-α, and IL-1β—activates microglia and astrocytes, propagating central neuroinflammation. Concurrent blood–brain barrier (BBB) dysfunction, driven by cytokine-induced tight junction degradation and endothelial apoptosis, permits peripheral immune mediators to enter the CNS, exacerbating damage. Oxidative stress and mitochondrial dysfunction further disrupt energy metabolism and amplify neuronal vulnerability. At the cellular level, microglia adopt a pro-inflammatory M1 phenotype, releasing neurotoxic cytokines and glutamate, while astrocyte dysfunction impairs glutamate clearance, water homeostasis, and BBB support. Neuronal apoptosis, synaptic loss, and increased tau pathology suggest that POD may unmask or accelerate neurodegeneration. Understanding these interconnected pathways offers opportunities for mechanism-based prevention, including cholinergic support, anti-inflammatory strategies, and perioperative biomarker-guided risk stratification.

To examine maternal risk factors for congenital syphilis (CS). We used a retrospective, population-based cohort of births in California (2011-2021) with linked birth certificates and hospital records. Modified Poisson regression models with robust standard errors were used to assess characteristics associated with CS. Among dyads with CS, maternal syphilis documentation was also examined. Of 4,481,096 births, 4659 (0.1%) had maternal syphilis without CS, and 2608 (0.06%) had both maternal syphilis and CS. CS was associated with having public insurance, tobacco use, drug use disorders, and residence in fringe-metro or medium/small-metro counties. Among CS dyads, 62.0% had no maternal syphilis documentation. There was a lower risk of no maternal syphilis documentation among those with <12th grade education; non-Hispanic Black identity; tobacco, cannabis, or drug use disorders; mental health conditions; and inadequate prenatal care. Universal prenatal syphilis screening, treatment, and documentation are essential to preventing CS.